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Neuroinflammation in Radiation Maculopathy: A Pathophysiologic and Imaging Perspective.

Giulia Midena1, Raffaele Parrozzani2, Marisa Bruno1

  • 1IRCCS-Fondazione Bietti, 00198 Rome, Italy.

Cancers
|August 14, 2025
PubMed
Summary

Radiation maculopathy (RM) is now understood to be driven by neuroinflammation, not just vascular issues. Neuroinflammatory hyperreflective foci (I-HRF) detected by OCT are early biomarkers for preclinical diagnosis and treatment.

Keywords:
chorioretinal imaginghyperreflective retinal focineuroinflammationradiation maculopathy

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Radiology

Background:

  • Radiation maculopathy (RM) is a severe complication of ocular radiotherapy.
  • Emerging evidence highlights neuroinflammation, involving microglial activation and cytokine dysregulation, as central to RM pathogenesis.
  • Hyperreflective retinal foci of neuroinflammatory origin (I-HRF) are critical early biomarkers.

Purpose of the Study:

  • To review the pathophysiology of neuroinflammation in RM.
  • To explore associated imaging parameters, particularly I-HRF.
  • To synthesize experimental and clinical findings on RM biomarkers.

Main Methods:

  • Literature review of experimental and clinical studies.
  • Synthesis of data on neuroinflammation in RM.
  • Focus on optical coherence tomography (OCT) for imaging biomarkers.

Main Results:

  • I-HRF are significant early indicators of neuroinflammation in RM.
  • OCT facilitates the identification and quantification of I-HRF.
  • These biomarkers correlate with microglial activation and cytokine changes.

Conclusions:

  • RM pathophysiology is shifting from a vascular to a neuroinflammatory paradigm.
  • I-HRF serve as crucial early biomarkers for RM.
  • I-HRF enable potential preclinical diagnosis and therapeutic strategies for RM.